How to prevent suicide?

Five words few people ever say, five words that are scary even to contemplate, five words that might make a life-or-death difference.

Nearly 300 educators, medical professionals and mental health experts from across San Joaquin County jammed into a conference room Thursday morning to examine one of the "final taboos" in American society:

Suicide.

And they learned that the five words in that question need to be uttered more often.

Suicide, particularly youth suicide, was the topic of a symposium, the county's first, that tackled the sensitive, almost-unspoken issue.

Prevention was the goal.

"When you connect with kids, you give a little piece of your heart," said Richard Lieberman, the keynote speaker. "It's extraordinary what we're dealing with in the schools. It's no one thing; it's no one person who's to blame. It's complex."

Lieberman is coordinator for suicide-prevention services with Los Angeles Unified, the nation's second largest school district.

Some of what symposium participants learned:

San Joaquin County: Loss is a big reason for depression. And depression can lead to despair. "Unfortunately in our community, we have a lot of losses. Losing jobs and homes makes kids particularly vulnerable," said Jean Anderson, with county Behavior Health Services.

School campuses: Young people considering suicide often tell someone ahead of time. Usually, it's a friend. "Kids talk to kids, not educators," Lieberman said. Learn to listen, pay attention and respond.

There is a difference: Bullying over time impacts boys; frequency isn't an issue with girls (one incident can be devastating). Rates of suicide have risen over the past three years for both genders, but girls even more so. Other factors for girls might be substance abuse and depression. For boys, it more likely is behavior disorder.

Avoid absolutes: There are multiple factors behind suicide, and the aftermath lingers. Lieberman said "closure is a media term ... the healing takes many, many years." There are no single-cause explanations. Ninety-five percent of those who die from suicide "have mental-health issues" as well as other external factors, Lieberman said. Cyber bullying is one of the newer influences.

Prevention techniques: Vic Singh, director of San Joaquin County Behavior Health Services, said community members need to "stand together, and say, 'Not one more.' " Just as millions of Americans have learned CPR (cardiopulmonary resuscitation), they can learn QPR (question, persuade and refer), said Ken Fitzgerald, a regional health and safety-planning coordinator. Lieberman, known by students in Los Angeles as "the suicide man," pointed to the room and said those assembled were "change agents."